Department of Pneumology and Critical Care Medicine), German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC-H), Thoraxklinik University of Heidelberg, Röntgenstrasse 1, 69126, Heidelberg, Germany.
Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, German Center for Lung Research (DZL), LMU University Hospital, Ludwig-Maximilians-University (LMU), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany.
Respir Res. 2024 Jul 13;25(1):274. doi: 10.1186/s12931-024-02902-2.
Patients with COPD are often affected by loss of bone mineral density (BMD) and osteoporotic fractures. Natriuretic peptides (NP) are known as cardiac markers, but have also been linked to fragility-associated fractures in the elderly. As their functions include regulation of fluid and mineral balance, they also might affect bone metabolism, particularly in systemic disorders such as COPD.
We investigated the association between NP serum levels, vertebral fractures and BMD assessed by chest computed tomography (CT) in patients with COPD.
Participants of the COSYCONET cohort with CT scans were included. Mean vertebral bone density on CT (BMD-CT) as a risk factor for osteoporosis was assessed at the level of TH12 (AI-Rad Companion), and vertebral compression fractures were visually quantified by two readers. Their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP), Mid-regional pro-atrial natriuretic peptide (MRproANP) and Midregional pro-adrenomedullin (MRproADM) was determined using group comparisons and multivariable analyses.
Among 418 participants (58% male, median age 64 years, FEV 59.6% predicted), vertebral fractures in TH12 were found in 76 patients (18.1%). Compared to patients without fractures, these had elevated serum levels (p ≤ 0.005) of MRproANP and MRproADM. Using optimal cut-off values in multiple logistic regression analyses, MRproANP levels ≥ 65 nmol/l (OR 2.34; p = 0.011) and age (p = 0.009) were the only significant predictors of fractures after adjustment for sex, BMI, smoking status, FEV% predicted, SGRQ Activity score, daily physical activity, oral corticosteroids, the diagnosis of cardiac disease, and renal impairment. Correspondingly, MRproANP (p < 0.001), age (p = 0.055), SGRQ Activity score (p = 0.061) and active smoking (p = 0.025) were associated with TH12 vertebral density.
MRproANP was a marker for osteoporotic vertebral fractures in our COPD patients from the COSYCONET cohort. Its association with reduced vertebral BMD on CT and its known modulating effects on fluid and ion balance are suggestive of direct effects on bone mineralization.
ClinicalTrials.gov NCT01245933, Date of registration: 18 November 2010.
慢性阻塞性肺疾病（COPD）患者常伴有骨矿物质密度（BMD）降低和骨质疏松性骨折。利钠肽（NP）被认为是心脏标志物，但也与老年人的脆性相关骨折有关。由于其功能包括调节液体和矿物质平衡，它们也可能影响骨代谢，特别是在 COPD 等系统性疾病中。
我们研究了 COPD 患者的 NP 血清水平与胸部 CT（CT）评估的椎体骨折和 BMD 之间的关系。
纳入了 COSYCONET 队列的 CT 扫描参与者。在 TH12 水平（AI-Rad Companion）评估 CT 上的平均椎体骨密度（BMD-CT）作为骨质疏松的危险因素，并由两位读者进行椎体压缩性骨折的视觉量化。使用组间比较和多变量分析来确定它们与 N 端前 B 型利钠肽（NT-proBNP）、中段前利尿钠肽（MRproANP）和中段前肾上腺髓质肽（MRproADM）的关系。
在 418 名参与者（58%为男性，中位年龄 64 岁，FEV 预测值 59.6%）中，TH12 处发现了 76 名（18.1%）椎体骨折患者。与无骨折患者相比，这些患者的血清水平升高（p≤0.005）MRproANP 和 MRproADM。在多元逻辑回归分析中使用最佳截断值，MRproANP 水平≥65nmol/l（OR 2.34；p=0.011）和年龄（p=0.009）是调整性别、BMI、吸烟状况、FEV%预测值、SGRQ 活动评分、日常体力活动、口服皮质类固醇、心脏病诊断和肾功能损害后骨折的唯一显著预测因子。相应地，MRproANP（p<0.001）、年龄（p=0.055）、SGRQ 活动评分（p=0.061）和主动吸烟（p=0.025）与 TH12 椎体密度相关。
MRproANP 是我们来自 COSYCONET 队列的 COPD 患者骨质疏松性椎体骨折的标志物。其与 CT 上椎体 BMD 降低的相关性及其对液体和离子平衡的已知调节作用表明其对骨矿化有直接影响。
ClinicalTrials.gov NCT01245933，注册日期：2010 年 11 月 18 日。
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